MSRA Comprehensive MSRA 2 — Questions and Answers
Question 1: The MSRA is composed of which two papers?
- Professional Dilemmas and Clinical Problem Solving (Correct answer)
- Anatomy and Physiology
- Ethics and Law
- Communication and Leadership
Correct answer: Professional Dilemmas and Clinical Problem Solving
The MSRA consists of the Professional Dilemmas (SJT) paper and the Clinical Problem Solving (CPS) paper.
Question 2: A patient presents with a sudden, severe, thunderclap headache reaching maximum intensity within seconds. What is the most important diagnosis to exclude?
- Tension headache
- Subarachnoid haemorrhage (Correct answer)
- Sinusitis
- Migraine
Correct answer: Subarachnoid haemorrhage
A thunderclap headache peaking instantly is the classic presentation of subarachnoid haemorrhage and must be excluded urgently.
Question 3: In the Professional Dilemmas paper, what is the primary principle that should guide most answers?
- Protecting your own reputation
- Patient safety and welfare (Correct answer)
- Avoiding extra work
- Following the most senior person without question
Correct answer: Patient safety and welfare
Patient safety is the overriding priority that should guide situational judgement responses.
Question 4: A 65-year-old smoker presents with haemoptysis, weight loss, and a persistent cough. What is the most appropriate initial investigation?
- Chest X-ray (Correct answer)
- Bronchoscopy
- Sputum culture only
- Reassurance and review in 6 months
Correct answer: Chest X-ray
A chest X-ray is the appropriate first-line investigation for suspected lung cancer before further imaging.
Question 5: You notice a colleague appears to smell of alcohol while on duty. What is the most appropriate first action?
- Ignore it as it is not your concern
- Discreetly raise your concern with a senior or supervisor (Correct answer)
- Confront them aggressively in front of patients
- Post about it on social media
Correct answer: Discreetly raise your concern with a senior or supervisor
Patient safety requires escalating the concern appropriately to a senior, while handling it discreetly and professionally.
Question 6: Which medication is first-line for an acute exacerbation of asthma in an adult?
- Oral antibiotics
- Inhaled or nebulised salbutamol (Correct answer)
- IV magnesium as first step
- Beta-blockers
Correct answer: Inhaled or nebulised salbutamol
Inhaled or nebulised short-acting beta-2 agonists such as salbutamol are first-line in acute asthma.
Question 7: A patient with type 2 diabetes has an HbA1c of 75 mmol/mol despite metformin. What is the most appropriate next step?
- Stop all medication
- Add a second oral hypoglycaemic agent (Correct answer)
- Immediately start insulin only
- Reduce metformin dose
Correct answer: Add a second oral hypoglycaemic agent
When metformin alone fails to control HbA1c, adding a second agent such as a sulfonylurea or SGLT2 inhibitor is appropriate.
MSRA Comprehensive MSRA 2
The MSRA is composed of which two papers?